Acute renal failure in the postpartum due to calcified myoma: a case report.

BACKGROUND: It has been reported that delivery can be a cause of urine retention. This complication occurs especially in case which are associated with a pelvic mass like calcified uterine myoma. But this unusual aspect of myoma can make ultrasonographic traps. OBJECTIVE: To report an unusual case of calcified uterine myoma which was unnoticed during pregnancy and made so obstructive renal failure few days after the delivery. CASE REPORT: Seven days after delivery a Twenty-nine-year-old Senegalese woman was admitted at a private hospital for a slight alteration of consciousness(Glasgow Coma Scale at 12). Emergency check-up showed an acute obstructive renal failure. Biological investigations showed ascendancy of granulocytes, deterioration of renal function with creatinin in 78 mg / l and urea in 1.82 g/l. Ultrasonographic examination revealed bilateral dilatation of renal calyces and an interstitial calcified uterine myoma compressing the bladder. Management consisted on a urethral catheterization of bladder, correction of hydro-electrolytic troubles and antibiotherapy (ciprofloxacin).Global evolution leads to fast fully consciousness, with disappearance of biological and ultrasonographic disorders. CONCLUSION: Calcified myoma can look like cephalic pole during pregnancy. This unusual aspect can be sometimes source of acute obstructive renal failure requiring urinary drainage in emergency. Improvement of women's management during postpartum can prevent such complications.

[Seroprevalence of HBsAgs in patients with rheumatoid arthiritis in a hospital setting in Senegal]. / Séroprévalence de l'antigène HBs au cours de la polyarthrite rhumatoïde en milieu hospitalier Sénégalais.

PURPOSE: Rheumatoid arthritis is the most common chronic inflammatory joint disease in adults. In Senegal, where biotherapy is unavailable, treatment of RA relies on a combination of glucocorticoids and disease-modifying antirheumatic drugs (DMARD). Since DMARD, particularly methotrexate, induce hepatotoxicity pretreatment assays of serum transaminase and albumin levels, as well as serological tests for the hepatitis B and C viruses is recommended. Hepatitis B virus (HBV) infection is endemic in Africa, particularly in Senegal. The purpose of this study was to assess the seroprevalence of the HBV surface antigen (HBsAg) for HBV in 258 patients with RA in Senegal as a basis for defining the least hepatotoxic DMARD for these patients and ensuring the most suitable monitoring. METHOD: This retrospective study was based on a review of the medical records of patients examined between January 2005 and December 2009 at the rheumatology outpatient clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal. All patients met the American College of Rheumatology criteria for RA. RESULTS: A total of 258 patients were tested for HBsAg. Tests were positive in 6 for a seroprevalence of 2.3%. All 6 positive patients were women with a mean age of 48.7 years (range, 16-79 years). Transaminase levels were normal in 5 patients. In the remaining patient, ASAT level elevation were twice normal and ALAT was normal. No patients had clinical evidence of liver disease. CONCLUSION: HBsAg seroprevalence in our population of patients with RA was lower than in the general population of Senegal: 2.3% versus 15%-18%. No evidence indicated that HBVinfection produced specific features in patients with RA. Based on these findings, widespread use of methotrexate in optimal dosages appears safe in patients with RA in Senegal. Treatment should be accompanied by careful attention to HBV prevention.

[Hematologic and immunologic signs of lupus: the experience of the hospital of Dakar]. / Les manifestations hématologiques et immunologiques de la maladie lupique: l'expérience du centre hospitalo-universitaire de Dakar.

INTRODUCTION: The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immune pathology, characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The circumstances of discovery are variable and polymorphic. The hematologic signs and the immunological disorders constitute criteria of diagnosis of lupic disease. METHODOLOGY: It is a multicentric retrospective study from January 1, 1997 to September 30, 2006. Patients were followed up in Internal medicine of Dakar. We appreciate the hematologic and immunological aspects appreciate their prognosis prevalence and their implications with the course the lupic disease. RESULTS: 142 lupic patients were included with 125 women and 17 men; the sex ratio is 0.13. The average age was 34 years with extremes of 6 and 72 years. Our patients had hematologic manifestations average in 32,4 % of the cases and immunological in 76,8 % of the cases. The immunological tests showed the presence, of antinuclear antibodies in 97,9 % of the cases, of native antibody anti-DNA in 45,7 % of the cases, the anti-ECT in 86,95 % (with the anti-RNP in 78,3 % of the cases, anti-Sm in 56,5 % and of anti-SSA in 87 % of the cases). Antibodies anti-DNA and anti-ECT were associated with the hematologic demonstrations respectively in 92,0 % and 95 % of the cases (p = 0,08). Total survival in 96 % of the cases is estimated to 7 years. CONCLUSION: The circumstances of discovery of the lupic disease are variable. The hematologic signs constitute criteria diagnosis of lupic disease. The accessibility of the hematologic and immunological assessment is necessary for an early diagnosis and an early treatment.

[Systemic vasculitis: study of 27 cases in Senegal]. / Vascularites systémiques: 27 observations au Sénégal.

Studies on vasculitis in black Africa are rare. The purpose of this report is to describe a retrospective study of systemic vasculitis managed in the internal medicine, ORL and cardiolology departments of the Aristide le Dantec University Hospital in Dakar, Senegal from 1995 to 2007. A series of 27 cases involving 7 men and 20 women with a mean age of 49 years was compiled. Primary vasculitis included Horton disease in 3 cases, Wegener disease in 2, Takayasu disease in 1, and Buerger disease in 1. Secondary vasculitis included mixed cryoglobulinemia with Gougerot Sjögren syndrome in 7 cases, primary Goujeröt syndrome in 4, rheumatoid arthritis in 3, nodosa periarteritis with hepatitis B in 2, SHARP syndrome in 1, and polymyositis in 1. The remaining two cases involved abdominal periaortitis including one associated with retrosperitoneal fibrosis and tuberculosis and the other with spondylarthropathy. Corticotherapy in combination with anticoagulants, immunosuppressive therapy, and surgery, when necessary, allowed effective management in 24 cases. The findings of this study show that systemic vasculitis can have numerous etiologies and indicate that secondary forms are the most common. Appropriate care modalities are needed to prevent severe outcome in Senegalese hospitals.

[Tuberculosis and systemic diseases: study of 8 Senegalese cases]. / Tuberculose et maladies systémiques: Etude de 8 cas sénégalais.

PATIENTS AND METHODS: A retrospective study (2000-2007) of the tuberculosis observations during systemic diseases was conducted in the service of Internal Medicine of hospital Aristide Le Dantec of Dakar. RESULTS: 8 (4 men and 4 women) has been received. The mean age was 54.5 years. The localization of tuberculosis was lung (n=8) with pleurisy (n=2), ganglionic (n=1), vertebral (n=1) and an abscess of the psoas (n=1). The diagnosis of tuberculosis had been carried with the bacteriological analysis of the expectorations (n=7), the histology (n=1). The systemic diseases was: rheumatoid arthritis and Sjögren's syndrome (n=3), primary Sjögren's syndrome (n=4), autoimmune thrombopenia (n=1). The diagnosis of systemic diseases was previous to that of tuberculosis in 7 cases and concomitant in 1 cases. Under chemotherapy and corticosteroid therapy, the evolution was favorable in 6 patients. CONCLUSION: our study confirms the frequently character spread by the tuberculosis in patients affected by systemic diseases. This association enhances diagnostic and therapeutic problems.

[Etiologic profile of cervical adenopathology observed in an internal medicine department in Dakar, Senegal. A 66 case series]. / Profil étiologique des adénopathies cervicales en médecine interne: étude de 66 observations à Dakar (Sénégal).

Cervical adenopathy is a frequent reason for hospitalization in the internal medicine department. This finding can be a sign of severe disorder requiring early diagnosis. The purpose of this retrospective study was to describe clinical features and evaluate diagnostic tests especially lymph node biopsy associated with evaluation of patients presenting cervical adenopathies in an internal medicine department in Senegal. Records of a total of 8610 patients treated in the Internal Medicine Department of the Aristide Le Dantec Hospital of Dakar, Senegal over a 68-month period from January 1, 2000 to August 20, 2006 were reviewed. Sixty-six files were included for study. A structured questionnaire was used to collect sociodemographic, clinical and paraclinic data. There were 37 men and 29 women. Average patient age was 34 years (range, 15 to 73 years). The side of the neck was the most frequent location of adenopathy followed by the pericervical arterial circle and anterior cervical area. Thirty-six patients presented superficial adenopathy in other locations including the armpit (39%), groin (32%) and elbow (1.5%). The etiologies underlying cervical adenopathy included classic causes such as tuberculosis that is the main cause in tropical regions and lymphoma that frequently led to macroadenopathy as well as novel causes such as Rosaï Dorfman Destombes syndrome.

[Destombes Rosaï Dorfman syndrome: description of one case and diagnostic challenges in the tropical setting]. / Syndrome de Rosaï Dorfman Destombes à propos d'une observation: difficultés diagnostiques en milieu tropical.

Destombes Rosaï Dorfman (DRD) syndrome is form of nonlangerhans cell sinus histiocytosis. The main symptoms are cervical adenopathy, fever and fluctuating hepatosplenomegaly. It can be confused with ganglionary tuberculosis especially in our region where tuberculosis is common. This report describes a case of Destombes Rosaï Dorfman syndrome in a 40-year-old woman from Senegal. The main presenting symptom was the presence of massive tumour-like lesions on the neck with altered general condition and fever. Based on these clinical findings, ganglionary tuberculosis was suspected and presumptive treatment was initiated in the local hospital. However further workup failed to confirm the diagnosis and the patient was transferred to the Internal Medicine Department. Clinical examination in our service revealed the presence of extensive adenopathy in the supraclavicular, axillary, and inguinal regions. Laboratory tests demonstrated a nonspecific inflammatory syndrome. Abdominal ultrasonography depicted extensive mesenteric and para-aortic adenopathy. Chest x-ray showed bilateral and asymmetric mediastinal adenopathy. Medullogram findings were normal. Histology confirmed DRD syndrome. DRD syndrome is rare disease of unknown aetiology. In tropical areas differential diagnosis with ganglionary tuberculosis, lymphoma, and reactive hemophagocytic syndrome can be challenging. Lymph node biopsy should be performed in all patients presenting fever and polyadenopathy.

[Monoclonal gammapathy of undetermined significance and autoimmune disease: description of three cases in Senegal]. / Gammapathies monoclonales de signification indéterminée et maladies auto-immunes: étude de trois observations sénégalaises.

Monoclonal gammapathy of undetermined significance (MGUS) has rarely been reported in African literature. The purpose of this article is to describe 3 cases of MGUS observed in women aged 63, 54, and 44 years in Senegal. All three patients had previously documented autoimmune disease, i.e., auto-immune thrombopenia, multiple auto-immune disease (comprising Sjögren's syndrome, polymyositis and vitiligo), and Sjögren's syndrome. Diagnosis of MGUS was made thanks to routine protein electrophoresis that demonstrated a monoclonal peak in the gammaglobulin area in all patients. Serum protein binding showed the IgG lambda subtype in one case and IgG kappa subtype in two cases. Medullogram findings were unremarkable with nondystrophic plasma cell rates ranging from 1 to 4%. Bisphophonate therapy was undertaken along with the recommended treatments for the associated autoimmune diseases, i.e., prednisone, hydroxychloroquine, and methotrexate. Treatment was successful in all three patients with stabilization of the associated diseases and of the monoclonal peak on subsequent electrophoresis. As of this writing, the mean duration of follow-up was 3 years. MGUS that has been uncommon in the African hospital setting should be screened for in all older patients or in patients presenting infection (especially due to virus) or autoimmune disease (as in the three cases presented herein). More systematic use of serum protein electrophoresis should reveal an increased incidence of MGUS. Diagnosis of MGUS requires regular clinical and laboratory surveillance due to the risk for complications of malignant hemopathies, especially multiple myeloma.

[Frequency of hematological and immunological manifestations of lupus in Dakar]. / Frequence des manifestations hematologiques et immunilogiques de la maladie lipique a Dakar.

INTRODUCTION: The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immun pathology characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The discovery circumstances of diagnosis are variable and polymorphic. The hematologic signs and the immunological disorders constitute the diagnosis criteria of the lupic disease. METHODOLOGY: It is a multicentric and retrospective study undertaken study from January 1, 1997 to September 30, 2006. Patients were followed up in the Internal Medicine of Dakar. We have studied the hematological and immunological aspects of the SEL and have evaluated the prevalence of lupic disease. RESULTS: 142 patients with lupic disease were included with 125 women and 17 men; the ratio--sex was 0.13. The mean age was 34 years with extremes of 6 and 72 years. Our patients had hematological and immunological manifestations in 32.4% and 76.8% of the cases. The immunological tests showed the presence of antinuclear antibodies in 97.9% of the cases, native antibody anti-DNA in 45.7% of the cases, the anti-ECT in 8.95% (with the anti-RNP in 78.3 % of the cases, anti-Sm in 56.5% and of anti-SSA in 87% of the cases). Antibodies anti-DNAand anti-ECT were associated the hematologic demonstrations respectively in 92% and 95% of the cases (p 0.08). CONCLUSION: The hematologic and immunoligical signs of lupus disease are frequent and constitute diagnostic criteria of the disease.

[Autoimmune cholangitis or seronegative biliary cirrhosis: report of one case]. / Cholangite auto-immune ou cirrhose biliaire séronégative: une observation chez un homme.

INTRODUCTION: Auto-immune cholangitis appears by a table of cholestatic jaundice without anomalies of the hepatic bile ducts. It is a primitive biliary cirrhosis without antimitochondrial antibodies. This disease is reported at adult women in 90 % of cases. We report a 59 years old man case. OBSERVATION: The patient was admitted for a diffuse melanodermy, a physical asthenia and a slimming which preceded 4 months by a pruritus with cholestatic jaundice. Biology showed a normal rate of transaminase. Alkaline phosphatases and direct bilirubine were high. Hepatitis (B and C) and HIV serologies were negative. Abdominal ultrasound showed a homogeneous liver. There were no dilations of the bile ducts. Antimitochondrial antibodies were negative and the histological examination confirms diagnosis. CONCLUSION: Progress was good with ursodesoxycholic acid even if interval is short (5 months of evolution).

[Nephrotic syndrom with focal and segmental glomerulosclerosis in Dakar: epidemiological and clinicopathological characteristics (about 134 cases)]. / Le syndrome néphrotique avec hyalinose segmentaire et focale a Dakar: aspects épidémiologiques et anatomocliniques (a propos de 134 cas).

Focal and segmental glomerulosclerosis (FSGS) is common and non-specific patterns of glomerular injury encountered in human renal biopsies. Cortico-resistant nephrotic syndrome is the main manifestation. We report epidemiological, clinical and pathological aspects of FSGS in Dakar. We report the results of a retrospective study about focal segmental glomerulosclerosis (FSGS) identified from 258 kidney biopsies performed in the medical clinic 1 of A. Le Dantec hospital from January 1993 to December 2003. FSG is found in 134 cases (52%), membranous glomerulonephritis in 32 cases (12,4%), minimal change disease in 20 cases (7.7%). Ninety eigths files were exploitable. FSGS has male gender predominance with a sex ratio of 3. Median age of patients is 28 years (15 and 79 years). Symptomatology is dominated by oedema in 86 cases (87,7%), hypertension in 12 cases (12.2%), hematuria in 5 cases (5.1%), nephrotic proteinuria in 65 cases (66,3%) and no nephrotic proteinuria in 33 cases (33.6%), renal failure in 25 cases (25%)and leucocyturia in 18 cases (18%). FSGS involving more than 50% of glomeruli is encountered in 41 cases (42%), severe interstitial fibrosis is associated in 26 cases. Different pathological aspects are: classical FSGS in 88 cases (88.7%), FSGS " collapsing" in 7 cases (7.1%), FSG "tip-lesion" in one case, FSGS associated to membranous glomerulosclerosis in 2 cases and to diabetic glomerulosclerosis in one case. FSGS is primitive in 88 cases (89,8%) and secondary in 10 cases (10.2%). FSGS is the most common primitive glomerulopathy in Dakar. Nephrotic syndrome is the main manifestation of this disease. Collapsing FSGS is not correlated with the HIV Infection.

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]. / Les pneumopathies interstitielles diffuses non specifiques au cours des connectivites: à propos de 7 observations à Dakar.

INTRODUCTION: The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases. CASES: We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy. CONCLUSION: Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

[Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV-1 infection: first Senegalese case report]. / Syndrome d'infiltration lymphocytaire diffuse ou DILS associé a une infection par le VIH -1: premier cas Sénégalais.

INTRODUCTION: The "Diffuse Infiltrative Lymphocytosis Syndrome" [DILS] is a seldom complication and even very particular case of HIV-1 infection, characterized by a merely syndrome and a systemic symptomatology superimposable to the figure met during the Gougerot-Sjögren Syndrome. GSS is nevertheless underlied by a lymphocyte infiltrate composed mainly of TCD8+ lymphocytes, while in the Gougerot-Sjögren syndrome (GSS), the lymphocyte infiltrate is essentially composed of TCD4+ lymphocytes. Despite the antiquity and significance of the HIV/AIDS pandemic, the DILS is not according to our knowledge individualized in the African literature. OBSERVATION: We are reporting a case revealed by a polyarthritis associated among others with a merely syndrome and a HIV-1 infection in a 32 years old Senegalese patient. Her CD4 rate was 327/mm3 and her viral load 17052. The biopsy of the accessory salivary glands showed a 4 grade lymphocite sialoadenitis according to Chisholm classification. The investigation of rheumatoid factors et anti-nuclear antibodies was negative. Under prednisone, hydroxychloroquine, methotrexate and tritherapy treatment, the evolution was favourable with a current return of 2 years. The rarity of DILS has pushed us to study its epidemiological, clinical, paraclinical, physiopathological and therapeutical aspects.

[Undesirable effects of methothrexate during treatment of rheumatoid arthritis]. / Tolerance du méthotrexate dans le traitement de lapolyarthrite rhumatoïde.

INTRODUCTION: Methotrexate used as antimetabolite since 40 years in cancerology, is curretly pointed out at weak dose in the treatment of rheumatoid arthitis. However, the intervening of undesirable effects is currently the principal factor limiting its use. The main of our study was evaluate the nature and the frequency of undesirable effects during treatement of rhumatoid arthritis by methotrexate in a prospective study in the department of internal medecine of A.L.D hospital. MATERIAL AND METHODS: Fifty patients were included in the study, they were 43 female and 7 male (sex ratio of 0.161).The mean age were 40.8 years, ranging from 18 to 68. The mean last of MTX treatment was 16.58 months, ranging from 1 to 64. RESULTS: Twenty seven patients (54%) had at least one undesirable effect. Undesirable effect appeared early in 74.1%. they were 61.5% when MTX was associated with others drugs versus 27.3% when MTX was used alone. Undesirable effects mostly were digestives (38%), general (30%), mucouscutaneous (8%) and hepatics (2%).for patients undesirable effects had involved. They were responsable of definitive stopping treatment in two cases of pulmonary tuberculosis.

[Current aspects of systemic lupus erythematosus in Dakar. About 74 cases]. / Aspects actuels du lupus erythemateux systemique a Dakar. A propos de 74 observations.

INTRODUCTION: previously reported studies on systemic lupus erythematosus in Senegal were more then ten years old and reported few cases of patients. Our objectives were to update epidemiological, clinical, laboratory and evolutive aspects of systemic lupus erythematosus throughout a study of 74 patients. PATIENTS AND METHODS: we conducted a retrospective study in the internal medicine and the dermatology units of the university teaching hospital Aristide Le Dantec from January 1993 to December 2002. All patients with systemic lupus erythematosus according to the ACR criteria were included. Those who didn't meet ACR criteria were excluded. RESULTS: we included 74 patients; their mean age was 32 years and the sex ratio 0.1 (male to female). At the entry general symptoms were constants, and cutaneous signs were found in 96% of cases, joints signs in 58.1% and renal sign in 56.8%. Haematological and immunologic abnormalities were nearly constant. All the patients received corticosteroids and in 35.71% they had in addition immunosuppressive drugs. Shorts term evolution was satisfactory. At the medium term 27.02% of the patients were lost and 10.81% of them died. CONCLUSION: currents aspects of systemic lupus erythematosus in Dakar are improved by the early diagnosis when the disease is pauci-symptomatic and by the use immunosuppressive drugs in association with corticosteroids.

[Pulmonary hypertension revealing systemic diseases: two Senegalese case reports]. / Hypertension arterielle pulmonaire revelant des connectivites: a propos de deux observations Senegalaises.

INTRODUCTION: Pulmonary hypertension (PH) is a complication of autoimmune diseases which worsen the prognosis. In Senegal, a few cases of PH have been previously reported in patients with systemic sclerosis. CASE REPORTS: We report two cases of patients with PH that revealed autoimmune diseases (Sharp' syndrome and Sjögren syndrome). Epidemiological, clinical, evolutive and laboratory data were analyzed. Evolution of disease was favourable for one patient and fatal for the other. CONCLUSION: These two cases show necessity of early diagnosis of systemic diseases in our countries. PH should be screened in each patient with autoimmune disease before installation of irreversible pulmonary arterial lesions that respond to treatment. New therapy used in idiopathic PH are not yet accessible for our patients.

[Still disease in adult: a Senegalese case report]. / Maladie de still de l'adulte: etude d'un cas Sénégalais.

INTRODUCTION: The adult Still's disease is a systematic disease rarely reported in the black Africans. We are reporting a case characterized among other difficulties by its diagnostic difficulties. OBSERVATION: It is about a 29 years old black Senegalese woman patient, without particular antecedents, which presented a systematic chronic syndrome composed of a pharyngitis, a polyarthritis and general symptoms (fever, chills, sweats, change of the general state), a cutaneous eruption, a polyadenopathy, a hepatosplenomegaly. The biological analyses showed among others, an inflammatory syndrome (VS at 115 mm in the 1st hour, CRP at 100 mg/L, WBC at 10,400/mm3 with neutrophilia), a hyperferritinemia in 643 ng/l with collapse of the glycosylated ferritin at 13% (N between 60 in 80%). After elimination of any autoimmune or neoplastic suppurative infectious pathology in the decline of a check up as exhaustive as possible, the diagnosis of a Still disease in adult had been retained. Their was improvement under the combination of prednisone and methotrexate. CONCLUSION: Although it is exceptional in black African, this pathology shall be however part of the differential diagnoses of any unexplained systematic sign. The dosage of the ferritinemia and its glycosylated fraction as well as the resort to the criteria of Yamaguchi and Fautrel's classification of Still Disease in Adult shall allow to establish more prematurely the diagnosis of this potentially severe affection.

[Lupus nephritis in Senegal: study of 42 cases]. / La néphropathie lupique au Sénégal: a propos de 42 cas.

INTRODUCTION: Renal involvement determines the prognosis of systemic lupus erythematosus. The aims of this study were to precise clinical, laboratory, therapeutic and evolutive aspects of lupus nephritis in Senegal in order to improve its management. PATIENTS AND METHODS: According to ACR criteria we included all patients presenting a systemic lupus erythematosus followed in internal medicine and in the dermatology services of university teaching hospital Aristide le Dantec of Dakar from January 1993 to December 2002. All the patients who didn't have a lupus nephritis defined by the existence of more than 0.5 g/24 h of proteinuria and or hematuria were excluded. RESULTS: The prevalence of lupus nephritis was 56.75% among 74 patients with systemic lupus erythematosus. Mean age was 29.6 years and sex ratio 0.13 (male to female). There was a nephritic syndrome in 45.23% of the cases and renal insufficiency in 37.71%. Renal biopsy performed in 52.38% of cases showed predominantly WHO classes IV and V. The key treatment was corticotherapy while immunosuppressive were used in 35.71%. The short term evolution was favourable but in the medium term, many patients were lost or followed up irregularly. CONCLUSION: To improve the management and the prognosis of lupus nephritis in Senegal it is necessary to make patients with a systemic lupus erythematosus sensitive to it and to make systematically urine tests aiming the screening for an early diagnosis of lupus nephritis. In addition we should have aggressive policies in order to lower the costs of immunosuppressive therapy and haemodialysis.

[Relation between lupus-antiphospholipids antibodies and heart disorders]. / Relation lupus-anticorps antiphospholipides et cardiopathie lupique.

BACKGROUND AND AIM: Antiphospholipids antibodies (APL) are autoantibodies found in lupus erythematosus and disorders like. Their frequency varies between 2 and 62% according to the literature. An increased frequency of cardiac disorders in antiphospholipids (APL) positive lupus has been reported. The aim of our study was to evaluate the role of APL as an independent risk factor of cardiac disorders in patients with systemic lupus erythematosus. MATERIAL AND METHOD: A prospective study during 14 months has been designed with the cooperation of dermatologic, internal medicine and cardiology departments of the Aristide Le Dantec hospital of Dakar. Platelets count (Beckmann Coulter analyzer), activated partial thromboplastin time (Diagnostiga stago analyzer) and antiphospholipids antibodies (Elisa) were determined. RESULTS: 37 patients affected by lupus were included in this study with a net feminine prevalence (89%); 8 (14.6%) had APL's significant results and 20 presented an echographic heart abnormality. The analysis of our data did not reveal an increased risk of cardiac diseases among APL positive lupic patients as compared to the negative group (p = 1). CONCLUSION: The presence of APL in patients with systemic lupus does not so seem to be an independant risk factor of heart diseases.

[Polyarticular gout in young adults: a curable rheumatic disease]. / La goutre polyarticulaire de l'adulte jeune: un rhumatisme curable.

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.